Leg cramps at night in women, men and children

Leg cramps at night can occur in people of different ages, different body types and with different complaints. Most often, cramps are short-term and disappear after the restoration of normal blood circulation. But sometimes they require systematic treatment and are severe.

Muscle spasms are sudden, involuntary, painful contractions of skeletal muscle.[ 1 ] They are characterized by electrically repetitive firings of motor unit action potentials at rates up to 150 per second,[ 2 ] more than four times the normal rate during maximal voluntary contraction.[ 3 ]

Muscle spasm was described as "a sudden, involuntary and painful contraction of the muscles that gradually decreases. During cramps, the affected muscles stiffen and the joints may be forced into unusual positions. In some people, cramps can be triggered by certain movements and/or stopped by stretching the muscles." This definition was based on descriptions in the literature [ 4 ] and on clinical experience describing cramps in patients.

Causes leg cramps at night

There are quite a number of reasons why leg cramps may occur at night. This is, first of all, a violation of metabolic processes, both at the cellular and tissue level. They can occur due to a deficiency of essential mineral components, vitamins. Also, disorders can occur due to trauma, prolonged compression and constriction of the muscle, in which not only metabolic processes are disrupted, but also blood circulation and innervation. There is also a sharp increase in the level of carbon dioxide and a decrease in the level of oxygen in the blood. The cause may be exhaustion of the body, insufficient level of physical and motor activity. [ 5 ], [ 6 ]

It is important to take into account that the causes of cramps are always individual. Therefore, serious diagnostics are needed. No specialist will be able to immediately name the cause of a cramp without conducting a corresponding comprehensive examination. Cramps can also occur due to pathologies such as pinched nerves, inflammation. It can be a consequence of pinched or displaced nerves, the development of arthrosis, osteochondrosis.

The cause may be disorders of the nervous and endocrine systems, pathologies developing against the background of nervous tension, stress, chronic fatigue. This is often observed against the background of pregnancy, lactation, as well as during the climacteric period, in postmenopause. Cramps can be a consequence of a lack of vitamins in the body, as well as a symptom of epilepsy or traumatic brain injury. Cancer and its treatment can cause problems that lead to patients experiencing leg cramps and other types of muscle spasms.

Why and what causes leg cramps at night?

Before you start treating leg cramps, you need to know exactly why they occur and why they get worse at night. To do this, it is advisable to see a doctor and undergo diagnostics. Only by knowing the exact cause of the pathology can you choose the appropriate treatment that will be effective.

• What is missing when you have leg cramps at night?

Usually, the occurrence of leg cramps, especially their intensification at night, is associated with the fact that the body lacks certain substances. What exactly is lacking can be determined during the diagnostic process. The doctor must conduct a thorough analysis, question the patient, collect a detailed medical history. It is important to know what diet a person has, what exactly may be lacking in it. Most often, cramps are associated with a lack of protein components, individual amino acids (mainly essential). Often there is a lack of vitamins. Muscles are especially sensitive to vitamins of group B, D. Also, with a lack of certain proteins, peptides, a similar condition may occur.

• Leg cramps at night with varicose veins

Varicose veins are accompanied by a sharp disruption of blood circulation and stagnation. Accordingly, the blood supply to internal organs and muscles is disrupted. The condition of muscle tissue, its contractile activity, and metabolism are disrupted. Exhaustion and disruption of innervation in muscle tissue occur. Metabolism is gradually disrupted. The removal of toxic substances, end metabolites, and carbon dioxide from the body slows down. The supply of oxygen and nutrients to muscle tissue slows down significantly. It is for this reason that the risk of developing leg cramps increases significantly with varicose veins. They generally intensify at night. But the reason for this phenomenon has not yet been fully clarified.

• Leg cramps at night with diabetes

In people with diabetes, the occurrence of seizures is associated with the presence of neuropathy, with increased excitability of the peripheral nerve. Type I diabetes has a lower percentage of seizures (about 60%) compared to type II diabetes (about 80%). In type II diabetes, nephropathy is another factor in the occurrence of seizures. Another probable cause of seizures is associated with changes in peripheral vascularization, causing episodes of ischemia and seizures.

With diabetes, the risk of developing leg cramps increases sharply, especially at night. This is due to the fact that diabetes is associated with metabolic disorders in various tissues, especially in muscle tissue. Mild intoxication and a lack of nutrients develop. The main disorder affects the state of the blood, which also affects the muscular system. In particular, elevated blood glucose levels negatively affect intracellular processes, muscle contractility, disrupt metabolic processes, and lead to intoxication.

• Cramp-fasciculation syndrome

Spasm fasciculation syndrome (CFS) is a peripheral syndrome associated with increased excitability of the peripheral nervous system. This situation leads to the presence of unwanted muscle spasms and / or fasciculations. Some subjects may experience other symptoms such as numbness and burning sensation typical of neuropathy. These patients often have antibodies to the detriment of potassium channels, with a predominance of the male gender. We have no adequate explanation or treatment for this condition.

• End stage renal failure

People with chronic kidney failure undergoing dialysis often suffer from muscle cramps, up to 50%, especially involving the lower extremities. Cramps may occur during dialysis or at home. Cramps in this type of patient are associated with depression, decreased quality of life, and sleep disturbances. The etiology of cramps in patients undergoing hemodialysis is unclear.

One possible cause is the presence of polyneuropathy, typical in these situations, with morphological and functional changes in the peripheral nerve fibers. Kidney transplantation significantly reduces the presence of seizures.

• Amyotrophic lateral sclerosis

About 95% of patients with amyotrophic lateral sclerosis (ALS) report seizures. The frequency and intensity of seizures are not related to the severity of the disease. The causes of these seizures are poorly understood, but they are likely related to increased neuronal excitability. Drugs that reduce seizures in these patients include mexiletine and quinine sulfate, the latter of which has serious contraindications.

• Cirrhosis

Muscle cramps are common and widespread in this patient population (88%). Electromyogram showed quite high activation of involuntary motor unit action potentials (EMPs) at over 150 Hz. Peripheral nervous system behavior is not related to neural degeneration. The underlying cause for the presence of cramps remains unclear. The presence of cramps varies by muscle area: cervical (9%), thigh (43%), lower leg (70%), toe (50%), abdominal muscles (12%), and fingers (74%). Other body areas may be affected. No direct relationship has been established between age or specific causes that lead to cirrhosis (alcohol, infection, etc.). It is known that there is no single cause or specific treatments to avoid cramps in patients with liver cirrhosis.

• Anti-myelin-associated glycoprotein antibody (anti-MAG) neuropathy

About 60% of patients have the phenomenon of cramps, especially affecting the lower limbs and upper limbs (only 20%). Most events occur at night or during exercise. There is no real explanation as to how this pathology is due to the presence of cramps, and there is no therapeutic strategy to limit this phenomenon.

• Fibromyalgia

According to the National Rheumatic Diseases Data Bank, seizures are one of the ten comorbidities affecting patients. One of the most likely causes is hyperexcitation of the peripheral nervous system. According to recent studies, the presence of seizures and peripheral neurological changes is directly related to the severity of the disease and inversely related to the quality of life.

Risk factors

The risk group includes people with a history of blood diseases, metabolic disorders, decreased immunity, injuries, congenital and acquired diseases of the musculoskeletal system. In particular, such conditions as cerebral palsy, diabetes mellitus, varicose veins, Dejerine syndrome, paralysis, hyperkinesis, peripheral vascular diseases, epilepsy, electrolyte imbalance, peripheral neuropathy, angina and arthritis should be considered as risk factors. The risk also increases significantly with innervation disorders, compression of blood vessels and nerves. A multicenter American study showed that patients with COPD suffer from 46% of muscle spasms, which is apparently the main cause of pain in this patient population. Another multicenter American study showed that 74% of cramps occur in athletes and in high ambient temperatures.

People with various disorders of nervous and hormonal regulation are also at risk. The risk of seizures increases significantly if a person lives and works in dampness, in conditions of high humidity. People suffering from various diseases are also at risk: lumbago, radiculitis, pinched nerves, arthritis, osteoarthritis, osteochondrosis, inflammatory processes. People with physical inactivity, who lead a sedentary, inactive lifestyle, long-acting beta-agonists, statins and diuretics are also at risk. [ 7 ]

The risk group includes elderly people due to the natural aging process of the body. [ 8 ] Pregnant women and nursing mothers also fall into this group, as their muscles are under increased strain.

Pathogenesis

Pathogenesis is based on molecular and biochemical processes affecting the cell, then the entire muscle tissue. First of all, biochemical reactions in the cells and tissues of the muscular system are disrupted, the mechanisms of calcium, potassium, and phosphorus metabolism are disrupted. The main links of the Krebs cycle, which ensures the normal functioning of the cell, also become pathological, and the mechanisms of carbohydrate and energy metabolism are disrupted. Contractile activity of muscles decreases, hypoxia develops, in which the body does not have enough oxygen, and oxygen starvation develops. Hypercapnia also develops, in which an excessive amount of carbon dioxide accumulates in the body, since the mechanisms for its removal are disrupted. [ 9 ]

It is worth noting that cramps often occur due to a violation of the permeability of the cell membranes of myocytes, in which a sufficient number of calcium ions cannot penetrate into the cell. An excessive amount of potassium accumulates in the cell, as a result of which the sodium-potassium pump (one of the mechanisms regulating the internal environment of the cell) is disrupted. In this regard, the main pathological processes develop, as a result of which spontaneous electrical activity of the cell occurs, the intracellular potential increases. This entails disturbances at the level of the entire muscle tissue, after which cramps in the legs occur (mainly at night). [ 10 ]

After this, all skeletal muscles are involved in the pathological process, they can periodically undergo spontaneous electrical activity, as a result of which the muscle contracts spontaneously and cannot completely relax.

Pathogenesis can also be associated with disturbances in nerve conduction, sensitivity and susceptibility of nerve receptors, and conductive pathways. Any link in the nervous system can be subject to pathological changes, from receptors that perceive changes occurring in the muscle to the corresponding parts of the brain that perceive and process information accordingly.

Epidemiology

According to statistics, every person, at least once in their life, under some circumstances, has had a cramp. Even the strongest people who keep themselves in good shape are subject to periodic cramps. Thus, many people have cramps when swimming, diving in cold waters, and winter swimming. Every second person has had a spontaneous cramp at night at least once. As a rule, they pass quite quickly, it is enough to change the position of the body, walk, put your foot on a flat surface, or simply rub the area affected by the cramp well. [ 11 ]

But it often happens that cramps occur due to the fact that systematic disorders occur in the body, resulting in prolonged compression of the muscle. Gradually, a stable condition develops, accompanied by a convulsive syndrome. As statistics show, about 50% of cramps occur due to a lack of certain substances, including vitamins and minerals. Another 24% of cramps occur spontaneously, under the influence of some factors of the external and internal environment, under the influence of trauma, damage. It is also worth noting that all other cramps occur mainly against the background of some diseases, metabolic processes, with insufficient mobility. We can say that cramps often occur due to the fact that a person leads a sedentary lifestyle (approximately 65% of pathology), the remaining 35% fall under congenital or acquired pathologies, due to which cramps occur. [ 12 ], [ 13 ], [ 14 ], [ 15 ]

Symptoms

The main symptoms of cramps include strong compression of the limb, in which a person complains that he cannot bend or straighten the limb. The muscles contract, tighten, contracture and pain occur. As a rule, if you work the muscle, rub it, the symptoms gradually subside due to the fact that blood circulation improves. The pain can also be pulsating, stabbing, and there is a feeling of cold in the limb.

The first signs of a cramp are considered to be a violation of the normal condition of the limb. This causes discomfort, a burning sensation, sometimes pain, and strong pressure in the muscle, a feeling of its excessive compression, squeezing. When the first signs appear, you need to see a doctor as soon as possible to make a diagnosis and prescribe the correct treatment.

There are several types of seizures, depending on the cause of their occurrence. Thus, there are congenital seizures, which occur in connection with the development of congenital diseases, are genetically determined and are poorly treatable, or do not respond to treatment at all. They progress rapidly. Often occur against the background of such pathologies as epilepsy, convulsive syndrome, various paralyses, dystrophies, neuropsychiatric pathologies.

The second type of cramps is acquired. They occur due to the peculiarities of a person's life. For example, they develop against the background of a lack of vitamins, certain substances in food, are a frequent complication of some diseases, are a consequence of metabolic disorders. Usually, in this case, etiological treatment is required, which is aimed at eliminating the cause of cramps, after which the state of the muscular system is automatically restored.

• Cramps in calf muscles at night

At night, the body relaxes, the load is removed from the legs and internal organs. Innervation and blood circulation improve. A large amount of oxygen suddenly enters the muscles, as a result of which a spasm develops from oxidative stress. At the same time, metabolic processes are disrupted, and metabolism accelerates.

To eliminate cramps, therapeutic physical training is widely used. It acts as the main treatment. Particularly effective are the means and techniques of active and passive gymnastics, correct breathing, stretching exercises and movement coordination. Various sets of breathing exercises can be used. The practice should consist of a sequence of static, dynamic and breathing exercises. It is better to finish with relaxation training, light meditation.

It is important to understand that without therapeutic exercise, no treatment will be effective. It is used to relieve pain, eliminate symptoms, improve muscle trophism, reduce or completely eliminate muscle tone disorders, and prevent bone and spine deformation. The selection of therapeutic exercise is determined primarily by the causes, as well as the main goals and objectives that need to be achieved. It is important to combine exercises with massage, manual therapy, and reflex gymnastic exercises. [ 16 ]

• Cramp in left, right leg at night

Leg cramps can occur for various reasons. They occur with equal frequency in both the left and right legs, and intensify mainly at night. This is due to the peculiarities of metabolism, the intensity of metabolic processes, blood circulation, and innervation. The lower the intensity of these processes, the lower the oxygen content and the higher the level of carbon dioxide. To relieve cramps, compresses and lotions are applied.

• Constant severe leg cramps at night

If the cramp occurs periodically, this is not a reason to worry. It can occur for various reasons, including due to impaired blood flow, compression of the limb, prolonged stay in the same position. But if the cramps in the legs become strong and constantly bother you, mainly at night, you need to see a doctor, undergo a comprehensive diagnosis. And determine the cause of the pathology. Then the optimal treatment will be selected, which will help quickly and in a short time get rid of the problem.

Instrumental diagnostics is one of the main methods that allows making a correct diagnosis. The methods used are CT, MRI, fMRI, electroencephalography. The essence of the methods is to study the electrical activity of various structures of the brain. Myoelectroencephalography determines the electrical activity of muscles. During the study, potentials are recorded. The result of such studies is the compilation of brain activity mapping, as well as muscle mapping.

Treatment is etiological, that is, it depends on what pathology is detected. For example, seizures often occur as a result of magnesium deficiency in the body, so it is necessary to prescribe magnesium preparations, and the situation will improve significantly. In case of disruption of normal functioning of the brain, the essence of therapy is to normalize its functional state. In case of pathology of the muscles themselves and circulatory disorders, it is necessary to resort to therapeutic exercise and restorative therapy. Manual therapy and massage are indicated. Basically, the therapy is quite long-term.

Medication therapy is used predominantly. Preference is also given to complex therapy (complex treatment includes appropriate physiotherapeutic methods, folk remedies, homeopathy). The most effective is etiological treatment, that is, it should be aimed at identifying and then eliminating the cause of the pathology. Symptomatic therapy is ancillary. Manual therapy, massage, exercise therapy, breathing exercises, exercise therapy, hatha yoga, qigong, swimming, and hydrotherapy are also used.

If emergency assistance is needed, symptomatic therapy is used to relieve the cramp itself and temporarily alleviate the condition. This includes manual manipulation, rubbing, kneading the affected area, which will provide access of blood and oxygen to the site of the cramp. Accordingly, this will relieve pain and relax the muscle. If this does not help, you need to take an anticonvulsant or antispasmodic. [ 17 ]

• Pain and cramps in legs at night

When pain and cramps in the legs occur, with their predominant increase at night, there is a need for diagnostics, determining the cause of the pathology and further treatment. Cramps accompanied by pain usually indicate that nerve fibers are involved in the pathological process, and severe damage to muscle fibers, cells and tissues occurs. They require mandatory treatment.

The basis of therapy consists of special anticonvulsants, anticonvulsants, muscle relaxants, and painkillers.

The simplest remedy used for cramps is no-shpa. Take one tablet 2-3 times a day (regardless of the presence or absence of cramps). The course of treatment is 10-14 days.

At the moment when a cramp occurs, this place should be massaged well, using light stroking at first, then deeper kneading and rubbing. Vibrating movements, as well as active-passive movements, muscle stretching, relieve cramps well.

For more severe and prolonged convulsions, carbazepam (3-5 mg/kg body weight) is used. It is recommended to take a course of treatment, on average 14-28 days.

The most powerful drug that helps to cope with convulsions is trometamol (60 mg/day, 2 times a day). The drug causes numerous side effects.

Various ointments are used for leg cramps. For example, troxevasin gel, travmalgon, dolobene, chondroitin, chondroxide, comfrey, meadowsweet, bee venom.

When cramps appear, it is necessary to take vitamins, since most cramps are associated with hypovitaminosis or avitaminosis. Cramps are often associated with a lack of vitamins A, E, PP.

Physiotherapeutic methods are also used. Of all the methods of physiotherapeutic treatment, various thermal procedures, electrical procedures, including electrophoresis, which allows the active substances to be delivered directly to the site of inflammation, and also increases the electrical activity of muscles and nerve impulses, have proven themselves to be the best. It is recommended to alternate physiotherapy with massage and manual therapy sessions.

Various water procedures help to relax muscles and relieve excessive tension and spasms: swimming in a pool, aqua aerobics, Charcot shower, hydromassage, jacuzzi, hirudotherapy, dousing, rubbing, compresses, hardening.

• Cramps in legs and arms at night

The appearance of cramps in the legs and arms at night indicates that the pathological process has affected a fairly large area of muscle and nerve tissue. In addition, this may be a sign of the development of a persistent convulsive syndrome that continues to progress.

In the process of diagnostics, it is important to separate the signs of one disease from another. This is primarily due to the fact that convulsions are a sign of many pathologies and diseases.

To conduct a diagnosis, you need to see a doctor. He will make a diagnosis and only on its basis can you select treatment. Various studies are used to make a diagnosis. The main methods are standard clinical tests, such as stool, urine and blood tests. They can be very informative.

Depending on the results obtained, a further research plan is developed. If necessary, functional tests are used, which can be very informative and allow for a fairly fine differentiation of various diseases and syndromes. Since seizures are often caused by a lack of vitamins or minerals, an analysis of the vitamin content in the body may be required. Sometimes genetic methods (genetic screening) are used if a genetic abnormality or congenital pathology is suspected.

• Cramps in toes at night

It is not uncommon to encounter such a phenomenon as leg cramps that appear and intensify at night. Most often, the reason is that a person either does not move enough, as a result of which metabolic processes in the lower parts of the body, in the limbs, and especially in the fingers, are disrupted, since this is the distal part. In addition, a similar picture is often observed against the background of such diseases as varicose veins, cramps, epilepsy, hypertonicity, vascular sclerosis, which only aggravate the pathology.

An equally common cause is, on the contrary, excessive strain on the legs and the musculoskeletal system. This is due to the fact that increased fatigue can also lead to excessive oxygen demand. When there is a lack of oxygen in the body, a spasm develops. Also, against the background of edema, cramps in the toes can develop, with a predominant increase at night. [ 18 ]

Leg cramps at night in a child

A child may have leg cramps for various reasons, especially pronounced at night. This may be due to a number of reasons, in particular, accelerated growth and development of the body, in which the skeletal growth processes proceed at an accelerated pace, while the muscular system does not keep up with the growth of bones. Accordingly, an imbalance and metabolic disorders occur, which are associated with the occurrence of cramps. It is also worth noting that cramps are often caused by nervous stress, overexertion, psychosis, and neurosis. Cramps are often observed against the background of experiences, stress, excessive emotions, both positive and negative. Cramps usually occur during the period when the child is in the adaptation stage: when changing a team, when moving from kindergarten to school, when entering a kindergarten or school. Cramps may occur with increased mental and physical stress. Cramps often develop in first-graders, as well as before important events and activities.

Leg cramps at night in a teenager

In adolescence, one often has to deal with such a problem as leg cramps. In a teenager, they develop most often at night. Most often, such a pathology is associated with the transitional period, when the body is rebuilt and adapted. During this period, numerous mental and physical neoplasms arise, the hormonal background changes, and metabolic processes are disrupted.

Teenagers can experience numerous experiences, stress, which can also cause cramps. Intense mental and physical activity, fatigue, lack of sleep, early rising can lead to the fact that a teenager also develops leg cramps. At night, they intensify due to the fact that the body relaxes, and by-products of metabolism begin to be intensively removed from previously clamped tissues, muscle fibers, the need for oxygen and nutrients increases sharply.

It is also worth noting that in adolescents, seizures can be associated with both insufficient levels of physical activity, movement, and excessive loads, muscle overtraining. Sometimes an incorrectly selected training regimen, improper nutrition, and a lack of certain substances in the diet can lead to the development of seizures.

Leg cramps at night in older people

Due to numerous age-related changes, adaptation processes, menopause, changes in hormonal levels, leg cramps often develop in older people, which intensify at night. Dystrophic and degenerative processes develop in the nervous and muscular systems, muscles age. Blood circulation, innervation, and nerve impulse conduction are disrupted.

It is also worth noting that the aging process is often accompanied by a decrease in the intensity of metabolic processes, as a result of which muscles and nerve fibers lack nutrients and oxygen. At the same time, the outflow of metabolites and toxins is also disrupted, which entails an increased content of carbon dioxide and metabolic by-products in the body.

Leg cramps at night during pregnancy

Muscle spasms in women during pregnancy are very common, about 50%; especially in the last 3 months and at night.

The exact cause of this disorder is not fully understood. It may be a change in neuromuscular function, excessive weight gain, compression of peripheral nerves, insufficient blood flow to the muscles, and increased work of the lower limb muscles.

During pregnancy, first of all, cramps and swelling in the legs develop, which mainly appear at night and in the morning. This is due to the high load on the lower limbs, as well as circulatory disorders. In addition, there is an accumulation of metabolic by-products, carbon dioxide, cells and tissues do not receive enough oxygen and nutrients. This leads to spasms, pain, cramps. Toxicosis intensifies these phenomena. Also, the symptoms increase under the influence of the increasing mass of the fetus, an increase in the woman's body weight, due to hormonal changes, immune and adaptation processes.

The prevalence of cramps in pregnant women in China affects the calf region, with a percentage of 32.9%. During the first trimester, the response is 11.6%, the second trimester, 28.2%, and the last trimester, 50.2%. Pregnant Indian women most commonly experience cramps in the third trimester, especially in the calf region (64.6%).[ 19 ],[ 20 ]

There is currently no adequate treatment to reduce the incidence of seizures.

Diagnostics leg cramps at night

In the process of diagnostics, differential diagnostics plays a key role, the essence of which is to separate the signs of one disease from another. This is primarily due to the fact that convulsions are a sign of many pathologies and diseases. For example, with equal probability, convulsions can be a consequence of a vitamin deficiency in the body, as well as a symptom of epilepsy or craniocerebral trauma.

To conduct diagnostics, you need to see a doctor (diagnostician, therapist, surgeon, traumatologist, orthopedist - there is quite a large selection of specialists here). They must make a diagnosis and only on its basis select treatment. During diagnostics, various diagnostic methods are used. Everything begins with a classic examination. If necessary, functional tests are used, which can be very informative and allow for a fairly fine differentiation of various diseases and syndromes. Laboratory and instrumental studies are also almost always used.

Tests

Various studies are used to establish a diagnosis, including laboratory ones. The main methods are standard clinical tests, such as stool, urine and blood tests. They can be very informative, if only because they show the approximate direction of further research. For example, tests can show whether an inflammatory, infectious, allergic or autoimmune process is developing in the blood. Depending on the results obtained, a further research plan is developed. For example, if a viral infection is suspected, various virological studies are prescribed. If a bacterial infection is suspected, bacteriological research, microbiological screening, cultures and scrapings may be prescribed.

If rheumatic and autoimmune processes in the body are suspected, rheumatic tests, C-reactive protein analysis, biochemical studies, and an immunogram are prescribed. If allergic diseases are suspected, allergy tests, an immunogram, and immunoglobulin E analysis are prescribed. An analysis of the vitamin content in the body may also be required if avitaminosis or hypovitaminosis is suspected, and other similar studies. Sometimes genetic methods (genetic screening) are used if a genetic abnormality or congenital pathologies are suspected.

Instrumental diagnostics

It is one of the main methods that allows you to make a correct diagnosis. Different methods are used in diagnostics, depending on what pathology is suspected. The essence is the use of special tools for diagnosis, registration of physiological and functional changes occurring in the body.

For example, to determine the causes of seizures, various methods of studying the functional activity of muscles and the brain are often used. Thus, MRI, fMRI, and electroencephalography are used. The essence of the methods is to study the electrical activity of various structures of the brain.

Myoelectroencephalography helps to study the electrical activity of muscles and, based on the data obtained, to assume the likelihood of developing a convulsive syndrome. The essence of using various methods of studying the brain is that, using special equipment, they record impulses, potentials recorded during the activation of various structures of the brain. Potentials are recorded. The result of such studies is the compilation of a map of brain activity, which is based on averaged and statistically processed data. It is also possible to create a graph of changes occurring in various structures of the brain. [ 21 ]

The method of functional magnetic resonance imaging can be quite informative. Its essence consists in recording individual potentials and studying the functional specialization of individual structures of the brain, identifying possible deviations from the norm, which can cause the development of seizures. The fMRI method is based on the reaction of electrodes to a local change in blood flow in the brain. Thus, any changes in the body, including seizures, spasms cause a local change in blood flow. As a result, the hemoglobin content in the blood changes. It is these dynamic changes that the system records. The result is issued in the form of a statistically processed graph, which reflects the features of the hemodynamic response to stimulation. Based on the results, a statistical map of brain activity can be created. [ 22 ]

Differential diagnosis

A spasm is a painful contraction of short duration and can be distinguished from other muscle contractions. Dystonia is a painless contraction of central origin, and myotonia is a long painless contraction, as in myotonic dystrophy and Thomsen dystrophy. Tetany may be painful, but rarely affects only one muscle area, as in Camurati-Engelmann disease, anorexia nervosa (Russell's sign), or in hypocalcemia. Myalgias are muscle pains that are not necessarily accompanied by contraction due to several causes, such as vitamin D deficiency, drug abuse, or spastic hypertension after central nervous system lesions. Muscle pain in the lower limbs when walking or intermittent claudication are symptoms of peripheral vascular stenosis. In these cases, a cramp may appear if the patient continues to walk. Restless leg syndrome is involuntary contractions of the lower extremities that do not cause spasms, but only pain and muscle fatigue when contractile activity ceases. Such contractions can also be symptoms of Parkinsonism.

A cramp is not a trigger point. The latter can be acute or latent and described in various ways. According to recent studies, the mentioned pain of a small area and a hypersensitive spot can be defined as a tight band. Another important factor is that a trigger point does not necessarily create pain; it can cause local or extended sensory disturbances, tingling, burning and dull pain.

For further differential diagnosis between a physiological seizure and a seizure due to pathology, the simplest examination is electromyography. More detailed tests such as magnetic resonance imaging or computed tomography can reveal any neurological lesions.

Another observational assessment to understand whether a cramp is benign is whether the localized musculature has developed a morphological abnormality: hypertrophy or atrophy. Weakness is another sign that may lead to the assumption that the cramp is a symptom rather than an isolated event. If there is a wind phenomenon, further muscle contraction is caused by very weak afferents.

In case of doubt, blood tests can be performed to detect myoglobinuria and hyperkalemia (more than 2-3 times the normal value). The literature emphasizes that muscle biopsy studies can also be performed to detect cellular changes such as atrophy or phenotypic changes.

There are seven differential symptoms for nocturnal leg cramp disorder (NLC) that can be compared with other sleep-related disorders: severe pain, a maximum period of 10 minutes of cramp presence, areas located as the calf or leg and, to a lesser extent, up to the thigh (quadriceps and sciatic muscles), pain that persists after the disappearance of cramps, changes in the sleep cycle and subsequent stress.

The essence of differential diagnostics is the need to differentiate the signs of one disease from the signs of another disease that has similar manifestations. It is also important to identify the cause of the pathology. Further treatment depends on the correct determination of the cause and pathogenesis. For example, if the cause is a deficiency of certain substances in the body, it is necessary to add these substances. If the cause is some pathology, it is necessary to take measures to get rid of it. In this case, special therapy may be required. At this stage, laboratory and instrumental research methods are widely used.

Complications and consequences

Convulsions are often accompanied by adverse effects and complications, which are primarily associated with circulatory, innervation, and metabolic disorders. Motor activity, nutrition, and blood supply to muscle tissue and nerves are disrupted. Pinched nerves are quite dangerous, as they can be accompanied by pain, progression of spasms and convulsions, followed by the development of an inflammatory process, and involvement of other organs and tissues in the pathological process.

The main complications are considered to be radiating pain and progressive convulsions. Convulsions can become chronic, which will be accompanied by periodic attacks, exacerbations. Temporary or permanent disability (depending on the severity of the condition), invalidity, unfitness for military service develop.

At first, leg cramps occur at night, and over time, they can also appear during the day. This is due to the destruction of muscle fibers, the accumulation of metabolic by-products. Also observed is a pinched nerve with a strong cramp, which subsequently develops into neuralgia with subsequent development of inflammation, chronicity of the process. Ultimately, paralysis can develop, which entails disability.

Prevention

Prevention is based on maintaining a high level of physical activity, regularly performing exercises aimed at normalizing blood circulation and respiratory processes. If necessary, you need to take a course of vitamins, and introduce additional magnesium-containing drugs into the body (since cramps often occur due to a lack of magnesium). [ 23 ]

It is also necessary to eat well, maintain water balance, work and rest schedule, eliminate stress and nervous tension. In addition, it is necessary to undergo regular medical examinations for people who are prone to seizures due to the presence of various structural or functional disorders of the brain and spinal cord, muscles, peripheral nervous system, genetic abnormalities and congenital pathologies. If treatment or preventive measures are required, they must be taken regularly. An important preventive measure is periodic completion of a course of therapeutic exercise, manual therapy, massage.

Forecast

If the necessary treatment and preventive measures are carried out in a timely manner, the prognosis may be favorable. Usually, leg cramps at night are easily eliminated with the help of medications. If you follow the doctor's recommendations, you can minimize or completely eliminate adverse effects. In the absence of adequate treatment, cramps can intensify and progress, up to the development of paralysis and disability. In healthy people, the prognosis for the occurrence of cramps is always favorable.